Patient-reported health outcomes in long-term lung transplantation survivors: A prospective cohort study

Abstract

During the last three decades lung transplantation (LTx) has become a proven modality for increasing both survival and health‐related quality of life (HRQoL) in patients with various end‐stage lung diseases. Most previous studies have reported improved HRQoL shortly after LTx. With regard to long‐term effects on HRQoL, however, the evidence is less solid. This prospective cohort study was started with 828 patients who were on the waiting list for LTx. Then, in a longitudinal follow‐up, 370 post‐LTx patients were evaluated annually for up to 15 years. For all wait‐listed and follow‐up patients, the following four HRQoL instruments were administered: State‐Trait Anxiety Inventory, Zung Self‐rating Depression Scale, Nottingham Health Profile, and a visual analogue scale. Cross‐sectional and generalized estimating equation (GEE) analysis for repeated measures were performed to assess changes in HRQoL during follow‐up. After LTx, patients showed improvement in all HRQoL domains except pain, which remained steady throughout the long‐term follow‐up. The level of anxiety and depressive symptoms decreased significantly and remained constant. In conclusion, this study showed that HRQoL improves after LTx and tends to remain relatively constant for the entire life span.

Transplantation experience as a predictor for quality of life during the first 6 months after lung transplantation

“…Several prospective studies have shown that QoL after lung transplantation improves significantly . In accordance with this previous research, we could demonstrate that QoL increased significantly in the first 3 months after the transplantation and remained stable in following the 3 months.…”

“…Prospective long‐term studies provide evidence that quality of life (QoL) after lung transplantation improves significantly and remains stable over a period until 15 years . According to recent studies, higher levels of post‐transplant depression and distress increase the risk for long‐term transplant‐related morbidity and mortality; thus, the psychological processes following transplantation may be crucial for the subsequent somatic outcome.…”

A Scoping Review of Key Health Items in Self-Report Instruments Used Among Solid Organ Transplant Recipients

“…Before transplantation, a patient’s HRQoL is significantly reduced due to clinical dysfunction of the failing organ and psychosocial distress. Shortly after transplantation, a significant increase in HRQoL is observed [ 11 , 12 ]. However, life-long, immunosuppressive regimens are necessary to prevent organ rejection, and chronic exposure to these medications is associated with complications that adversely affect the HRQoL of solid organ transplant recipients [ 13 – 15 ].…”

Primary graft dysfunction and health-related quality of life after transplantation: The good, the bad, and the missing

“…Assessing health‐related quality of life (HRQL), and other related health domains, has become an important tool in evaluating the outcomes of solid organ transplantation as evidence suggests transplant provides both HRQL and survival benefits 1–4 . Understanding HRQL is particularly important in organs, like the lung, where the survival benefit is more limited as compared to other solid organs.…”

“…In lung transplantation, single‐ and multicenter studies have reported patient‐perceived improvements in physical and mental domains across different HRQL instruments after transplantation 1–4 . However many of these studies are not recent and may not reflect modern practices, and have been limited by cross‐sectional design, and survivor bias 5,6 .…”